POS0944 PREDICTORS OF SUSTAINED REMISSION IN PEOPLE WITH AXIAL SPONDYLOARTHRITIS TREATED WITH BIOLOGIC DRUGS
Authors: B. Farisogullari, G. K. Yardimci, E. Bilgin, E. C. Bolek, E. Duran, G. Ayan, Z. Özsoy, G. Sandal Uzun, M. Ekici, E. Unaldi, L. Kiliç, A. Akdoğan, O. Karadag, Ş. A. Bilgen, S. Kiraz, A. İ. Ertenli, U. Kalyoncu, P. M. Machado
Journal: Annals of the Rheumatic Diseases (2022)

Background The ultimate goal of treatment in axial spondyloarthritis (axSpA) is sustained remission. Data on predictors of sustained remission are scarce in axSpA. Objectives To determine predictors of sustained remission in people with axSpA after treatment with their first biological disease-modifying anti-rheumatic drug (bDMARD). Methods Hacettepe University Rheumatology Biologic Registry (HUR-BIO) is a prospective, single center registry of rheumatic disease patients treated with bDMARDs. Patients with axSpA were selected and sustained remission defined as attainment of Assessment of SpondyloArthritis International Society partial remission (ASAS-PR) and/or Ankylosing Spondylitis (AS) Disease Activity Score C-reactive protein Inactive Disease (ASDAS-ID) for two or more consecutive visits spanning ≥6 months during follow-up. Patients achieving and not achieving sustained remission were compared using the independent t-test. Multivariable logistic regression analysis was performed to determine independent factors predictive of sustained remission. Variables with a p-value&lt;0.1 were re-tested in multivariable models. Forward selection was performed until the best-fit model was obtained, taking possible confounders into account. Two separate multivariable models were built, one with and one without the covariate “achievement of remission at 3-6 months”, to assess consistency of findings and to account for missing information regarding remission status between 3 and 6 months. Results Data on 990 patients with sustained remission data were available. Of these, 299 (30%) were in sustained remission, while 691 (70%) were not. Patients in sustained remission were younger, had earlier disease onset, were more frequently male, had lower BMI and were more frequently HLA-B27 positive, compared to patients not in sustained remission. Furthermore, at the start of bDMARD treatment, Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), and patient global assessment (PGA, 0-10 scale) were lower, while acute phase reactants (ESR and CRP) were higher, in the sustained remission group. In multivariable analysis, male gender (OR 2.2, 95% CI 1.21-3.95), concomitant conventional synthetic DMARD (csDMARD) use (OR 3.63, 95% CI 1.29-10.19), PGA (OR 0.96, 95% CI 0.95-0.98), and early achievement (between 3-6 months) of remission (OR 13.1, 95% CI 7.13-24.02) were independently associated with sustained remission (Table 1, model 1). In the model without the variable early achievement of remission (Table 1, model 2), similar and a few additional associations were described: age at diagnosis (OR 0.97, 95% CI 0.96-0.99), male gender (OR 2.31, 95% CI 1.60-3.35), concomitant csDMARD use (OR 1.88 95% CI 1.23-2.86), PGA (OR 0.98, 95% CI 0.97-0.99), BASDAI (OR 0.87, 95% CI 0.78-0.96), and baseline symptom duration (OR 0.97, 95% CI 0.94-0.99). Table 1. Multivariable analysis (best-fit model) of predictors of sustained remission Model 1 Model 2 Covariates Multivariable Analysis (n= 541 ) Multivariable Analysis (n=739 ) OR (95% CI ) p-value OR (95% CI ) p-value Age at diagnosis NS NS 0.97 (0.96-0.99) 0.006 Male sex 2.84 (1.71-4.70) &lt;0.001 2.31 (1.60-3.35) &lt;0.001 Concomitant csDMARD use (at baseline or follow-up ) 2.94 (1.57-5.51) 0.001 1.88 (1.23-2.86) 0.003 Baseline PGA 0.97 (0.96-0.98) &lt;0.001 0.98 (0.97-0.99) 0.002 Baseline BASDAI NS NS 0.87 (0.78-0.96) 0.009 Baseline symptom duration NS NS 0.97 (0.94-0.99) 0.021 Achievement of remission at 3-6 months after baseline 11.70 (7.11-19.23) &lt;0.001 NA NA NA: not applicable; NS: not selected (not contributing to the model). Baseline refers to start of bDMARD treatment. Conclusion This study demonstrates that patients in sustained remission after starting bDMARD treatment have distinctive characteristics compared to patients not in sustained remission. These data can be used to aid clinical and personalized management of axSpA, and to facilitate better communicate between health care professionals and patients regarding the course and prognosis of their condition. Disclosure of Interests Bayram Farisogullari: None declared, Gözde Kübra Yardimci: None declared, Emre Bilgin: None declared, Ertugrul Cagri Bolek: None declared, Emine Duran: None declared, Gizem Ayan: None declared, Zehra Özsoy: None declared, Gullu Sandal Uzun: None declared, Mustafa Ekici: None declared, Erdinc Unaldi: None declared, Levent Kiliç: None declared, Ali Akdoğan: None declared, Omer Karadag: None declared, Şule Apraş Bilgen: None declared, Sedat Kiraz: None declared, Ali İhsan Ertenli: None declared, Umut Kalyoncu: None declared, Pedro M Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB